EURORAD ESR

Case 72

Glandular epithelioma of the maxillary sinus with extension to the anterior and central skull base

Author(s)
Lemort M, Leurquin M
 
Patient
male, 59 year(s)

Clinical History

Large tumour of the maxillary sinus and ethmoid with nasal bleeding, proptosis, and facial hypoesthesia

Imaging Findings

This patient complaints of nasal obstruction, epistaxis, proptosis and right hemifacial hypoesthesy. ENT examination shows a right nasal tumour. MRI is performed with pre- and post contrast sequences and different spatial resolutions. The relevant questions to answer to are: What about the upper limits of the lesion? How may you explain the high signal in the right maxillary sinus on the T1 pre-contrast images? Describe and explain the signal characteristics of the lesion.

Discussion

The following sequences were used: T2w FSE coronal T1w SE axial and coronal pre- and post-Gd DOTA This tumour, centred on the ethmoid extends to the anterior skull base and anterior cranial fossa, with brain infiltration, to the right orbit, the right maxillary sinus. The T1 high signal is due to proteinaceous viscous contents of the retention material. The tumour before contrast appears heterogeneous due to combined necrosis and haemorrhages (see the necrotic areas appearing hypersignal on T2w images). Another explanation for high signal areas on T1 is retention of mucous substances in tumour. The histology showed a glandular epithelioma of the right maxillary sinus. The patient was treated with surgery and radiotherapy, unfortunately the disease evolved and he died a few months later.

Final Diagnosis

Glandular epithelioma of the maxillary sinus
 

MeSH

  1. Maxillary Sinus Neoplasms [C04.588.443.665.650.693.575]
    Neoplasms or tumors of the maxillary sinus. The majority of paranasal sinus neoplasms arise here. They develop silently when confined to the sinus and produce symptoms on extension through the walls.

Citation

Lemort M, Leurquin M (2000, Jan 17).
Glandular epithelioma of the maxillary sinus with extension to the anterior and central skull base, {Online}.
URL: http://www.eurorad.org/case.php?id=72
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  • Figure 1
    Axial T1W SE before (a-b) and after (c-d) Gd IV
    a b c d  

    Note the spontaneously high signal areas in the tumour extending to the central skull base and right cavernous sinus.

    Note the invasion of the right orbit, as of the whole ethmoid

    Contrast enhancement after Gd is heterogeneous, with areas of necrosis

    Same as 1b, after Gd

     
  • Figure 2
    Coronal T1W SE before (a-b) and after (c) Gd IV
    a b c  

    Note the high signal areas in the tumour

    There is high signal material in the outer part of the right maxillary sinus corresponding to retention changes. Note also inflammatory changes in the left maxillary sinus.

    Contrast enhancement helps to show the extent of the tumour infiltration in the anterior skull base.

     
  • Figure 3
    Coronal T2W FSE
    a b  

    The T2W images help to differentiate tumour limits from retention changes. Tumour has a relatively low signal.

    The T2W images help to differentiate tumour limits from retention changes. Tumour has a relatively low signal (same as 3a).

     
Figure 1

Axial T1W SE before (a-b) and after (c-d) Gd IV

Figure 1a
Note the spontaneously high signal areas in the tumour extending to the central skull base and right cavernous sinus.
 
Figure 1b
Note the invasion of the right orbit, as of the whole ethmoid
 
Figure 1c
Contrast enhancement after Gd is heterogeneous, with areas of necrosis
 
Figure 1d
Same as 1b, after Gd
 
Figure 2

Coronal T1W SE before (a-b) and after (c) Gd IV

Figure 2a
Note the high signal areas in the tumour
 
Figure 2b
There is high signal material in the outer part of the right maxillary sinus corresponding to retention changes. Note also inflammatory changes in the left maxillary sinus.
 
Figure 2c
Contrast enhancement helps to show the extent of the tumour infiltration in the anterior skull base.
 
Figure 3

Coronal T2W FSE

Figure 3a
The T2W images help to differentiate tumour limits from retention changes. Tumour has a relatively low signal.
 
Figure 3b
The T2W images help to differentiate tumour limits from retention changes. Tumour has a relatively low signal (same as 3a).
 
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